Positions and Tips on Pushing During Childbirth

You did it! You’ve made it through early labor, active labor, and transition labor, and now you are ready to start pushing during childbirth. Way to go, mama! If you have made it through these phases without pain medications, you are likely super exhausted and ready to get this baby out! If you’ve gotten an epidural, you have probably gotten some rest, may feel pressure in your bottom and are ready to push. Either way, it’s go time! It’s time to meet your baby. 🙂

When Is It Time To Start Pushing?

Once your cervix is 10cm dilated, 100% effaced, and your baby is (at the very least) at 0 station, you are now what we call “complete,” and this is when you can start pushing. Pushing during childbirth anytime before reaching 10cm could risk you tearing your cervix, which is a definite no-no. You want to wait until your midwife or doctor says that you are “complete” and that your cervix is completely dilated and effaced.

If your baby is at 0 station, your doctor or midwife might want you to “labor down” until your baby has gotten a bit lower, especially if you have an epidural. (Laboring down means continuing laboring and not starting pushing until your contractions have pushed your baby lower into the birth canal. +1, +2, and +3 stations are much better times to push since baby is getting closer to the outside world.)

They may want you to labor down because the longer you push, the more likely you will face complications. What are those potential complications?

The longer you push, the more likely your cervix could swell and not allow you to continue pushing and get baby out.
The longer that you push, the more tired you will become. Some women become so tired that they cannot finish pushing, so they need the vacuum, forceps, or a c-section.
It could cause your baby to be in distress (have their heart rate rising too high or falling too low) if in the birth canal too long, which would result in an emergency c-section.

The lower your baby is, the less pushing you have to do during childbirth, the shorter your pushing stage will be, and the sooner you will meet your baby!

What You May Feel

When it’s time to start pushing (if you do not have an epidural), you will feel a lot of pressure in your bottom and have an uncontrollable urge to push. Your body will automatically start pushing during childbirth when it’s the right time. You will feel that constant pressure down there whether you’re having a contraction or not. It feels almost as if you have to pass a major bowel movement. (I know, I know. You don’t want to think of birthing your child as passing a bowel movement, but it’s similar to what you will feel but more intense.)

If you do have an epidural, you should not be feeling your contractions, and you may or may not feel the pressure in your bottom. If you can’t feel anything (your contractions, your legs, the pressure), you will need your nurse or doctor to tell you when it’s time to begin pushing during childbirth because you won’t know when a contraction is coming and when it’s the right time to push. (FYI, you should only push during a contraction. Unless there is an emergency and you need baby out immediately, you only push during contractions.)

Since you have an epidural, you do not have complete control of your lower body, so the medical staff will have to support your legs and help you as you push. Sometimes women don’t know exactly how hard they are pushing. Everything is numb, so they don’t know if they are pushing hard enough or pushing too hard. The doctor or nurse will let you know how things are going, and they will coach you and guide you as baby comes down and out.

How Long Does Pushing Last?

I’ve seen women push their babies out in less than 3 minutes, and other women push for up to 3 hours. The women who pushed faster were the women who did not have an epidural. They had more control and could feel how and when to push. Women who are first-time moms with epidurals usually push for at least an hour and sometimes as long as 3 hours — depending on how long your doctor will allow you to push. First-time mothers who did not have epidurals usually pushed only minutes or up to an hour and a half. It just depends. And typically, the pushing time gets shorter with each child you have. Thankfully!

Positions and Tips on How to Push

How Do you Push?

This may sound like a silly question because you may be thinking, “Isn’t it natural? Isn’t my body supposed to know how to push my baby out?” The answer is a bit complicated because the answer is yes and no. It is natural, and your body will push for you, but to get some effective pushes and help shorten your pushing time, it’s good to know how to push correctly. I’ve seen many women not push effectively, so I wanted to give you some tips on how to push:

Without an Epidural

Listen to Your Body – If you need to stop and breathe during your pushes or move into a different position, do it! Typically doctors want you to hold your breath while they count to 10 slowly, and you push that whole ten count, but sometimes pushing that way can cause you to tear more. If you do not have an epidural, your body will tell you what’s working and what’s not. Listen to what your body is telling you and shut out what others might be saying (unless you push for too long, you want to listen to some advice). Doing what feels right is the best way to go.
Use Gravity – Get upright! The more that you use gravity to your advantage, the better. It’s a lot more difficult to push when you are on your back or on your side, which causes you to push for longer. But when you use gravity, it can help you while pushing during childbirth.
Push When You Feel the Urge – Since you do not have any drugs in your system, your body will tell you when to start pushing. Once you feel the next contraction coming, your body will naturally begin pushing your baby out, and you should follow that instinct. Don’t force anything if your body is not telling you to push. Rest in between pushes.

With an Epidural

Push During Contractions – You don’t want to waste your energy and push when you are not having a contraction. Your contractions are already helping push your baby down, so using that momentum helps get your baby lower. That will help make your pushes more effective.
Push with your Bottom – Some women start pushing their legs out when they push, or they end up holding their breath too much and pushing with their face. This is because they forget where they need to focus when pushing. Remember that your pushing energy needs to be in your bottom.
Open your Pelvis – With an epidural, there aren’t as many pushing positions available, but you want to make sure that you widen your pelvis and get it to open as much as possible. This is why many women pull their legs back while pushing to help get their pelvis open (as if it were in a squatting position) to allow their baby to get lower into their pelvis.

If you end up pushing for a while and are having difficulty getting baby out, I recommend you look in a mirror. I know… You probably don’t want to see what’s going on down there, but I will tell you, sometimes, when you have been pushing for too long, it’s helpful to see what you’re doing so you can see where to push. I’ve had several of my clients say, “Oooh! I see now where I need to push and what I need to do.” And they then push a lot more effectively. So a mirror can be a great tool.

What are the Different Positions I Can Push In?

The answer to this question greatly depends on where you plan to have your baby (at a hospital, home, or a birth center) and if you receive any pain medication (epidural or analgesic).

If you have chosen to have a natural birth (no pain medication) at the hospital or have your baby at home or at a birth center, here are your pushing options: